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Entries in Chronic pain
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Stories of the horrors of opiate over-prescription and abuse are abundant, and Maine has not been spared the ravages of that epidemic. In response to the growing problem, Governor LePage, in April of this year, signed into law a bill intended to place some limits on the prescription of opioids in situations involving both “acute pain” and “chronic pain”. Under the new law, health care providers will be limited to prescribing no more than a 30-day supply of opioid medication in any 30-day period for patients with chronic pain. However, there is no limit on the number of times that a 30-day prescription can be written by a provider. The practical impact on chronic pain patients in the workers’ compensation system will be one of two outcomes: either, patients will now have to visit their providers every thirty days rather than the every three to six months schedule typical in long-term workers’ compensation chronic pain cases; or providers will be decreasing the number of opioid prescriptions issued to chronic pain patients as their practices suffer from limits on the ability to accommodate every-thirty-day appointments for medication renewal.

On March 18, the CDC finally issued much-anticipated guidelines for the prescription of opioids in chronic pain management “outside of active cancer treatment, palliative care, and end-of-life care.” Over-prescription of opioids in the realm of workers’ compensation has long been an issue of national importance. 47,055 lethal drug overdoses occurred in the United States in 2014, the most recent year for which statistics are available, with 18,893 of those specifically prescription drug overdoses. Not all of those are tied to medication prescribed for work-related chronic pain management, but certainly, anyone who has been involved in workers’ compensation can attest to the “pill mills” in their local communities. The Northeast, with an aging, deconditioned work population and robust health insurance costs has been particularly at risk for non-occupational chronic pain complaints morphing into work-related injury claims with the resulting never-ending prescription of opioids for “pain management”. Pain cannot be objectively measured or objectively proven; it is inherently subjective and subject to individual experience and motivation. The CDC guidelines will, hopefully, provide measured guidance to physicians to assist in the proper use of prescription opioids in time-limited treatment protocols designed to address chronic pain.